Newborns with congenital heart disease are some of the most critical and fragile patients, says Dr. Amir Ashrafi, cardiac neonatologist at CHOC Children’s. To help address the needs of this complex patient population and their families, CHOC will once again be hosting NeoHeart: Cardiovascular Management of the Neonate. The conference will be held March 27-29, 2019 at the Hyatt Regency in Huntington Beach, and anticipated to attract over 650 attendees, from both across the country and internationally.

“It is imperative that physicians, nurses, and all front-line providers work closely together to give these babies the best chance at success” Dr. Ashrafi explains.

The dynamic, TED-style talk conference will emphasize cutting-edge science, innovations in medical care, controversies in management, as well as the importance of eliminating silos and creating an all-inclusive team which includes the families of neonatal patients. Physicians, physician’s assistants, nurses, nurse practitioners, fellows, residents, and other allied health professionals who specialize in neonatology, pediatric cardiology, pediatric intensive care, and cardiothoracic surgery are invited to attend.

Given the remarkable success of NeoHeart in previous years, Dr. Ashrafi, Dr. John Cleary, neonatologist at CHOC and colleagues from around the world launched the first international Neonatal Heart Society. The group works closely with other professional organizations including the American Academy of Pediatrics (AAP), World Congress of Cardiology, and Pediatric Cardiac Intensive Care Society to advocate for newborns with congenital heart disease and hemodynamic instabilities.

Staff decreased the number of babies who returned to the Surgical Neonatal Intensive Care Unit with body temperatures below 36 degrees Celsius from 10.7 percent to 1.3 percent following surgeries between September 2014 and August 2015.

Due to high body surface area, infants undergoing surgery are at risk for hypothermia, especially premature infants with decreased subcutaneous and brown fat. Hypothermia-induced vasoconstriction can lead to impaired wound healing, surgical site infections, impaired coagulation and decreased drug metabolisms, which can collectively increase perioperative morbidity, said Dr. Irfan Ahmad, co-director of the unit.

Though CHOC’s baseline figure was well below the national average rate of 15.6 percent, reducing post-operative hypothermia rates was identified as an area for quality improvement for the Surgical NICU and staff set out to reduce rates by half, Dr. Ahmad said.

Involving a cross-disciplinary team including nurses, neonatologists, surgeons and anesthesiologists, the project tracked 76 patients. Because infants can be at risk for hypothermia before surgery, intra-operatively and post-operatively, their temperatures were tracked during each operative stage. Staff were then able to identify problem areas and make improvements over each quarter.

Dr. Ahmad attributed the success to consistently implementing measures such as ensuring patients wore hats and blankets while headed to the operating room; pre-warming transport isolettes before placing babies inside; and using intra-operative heating devices during procedures.

Dr. Ahmad presented this data earlier this month to a quality congress held by the Vermont Oxford Network, a nonprofit, voluntary collaboration of health care professionals dedicated to the quality and safety of medical care for newborns and their families.

CHOC established its Surgical NICU in October 2013, and remains one of a handful of hospitals nationwide to cohort infants needing and recovering from surgery in a dedicated space.

Surgical NICU patients receive care from a multidisciplinary team that includes neonatologists, surgeons and many other clinicians. The surgical NICU team cares for patients jointly, discussing the cases as a group and forming a treatment plan that often calls for the expertise of other specialties.

Patients and families are a key component of the surgical NICU care team, collaborating and partnering with clinicians on every stage of the patient’s care.

The Surgical NICU rounds out CHOC’s expansive suite of services for neonates, including a main NICU; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.

Dozens of representatives from neonatal intensive care units nationwide recently toured CHOC Children’s Small Baby Unit (SBU) and learned how to replicate the facility in their own hospitals as part of a conference held by the Vermont Oxford Network (VON).

About 50 attendees spent two days this month at CHOC, touring and attending workshops and roundtable discussions. Among the sessions was “Creating a Small Baby Program: The CHOC SBU Experience,” presented by Dr. Antoine Soliman, SBU director, and Mindy Morris, DNP, SBU program coordinator and nurse practitioner.

In that session, the pair defined key components and approaches of the program that help develop a team dedicated to the care of micro-preemies; identified strategies for staff engagement in developing tools and processes to standardize the care of babies with extremely low birth weights (ELBW); examined potential challenges and barriers to the development of an ELBW team, and devised possible solutions.

Morris also shared data accumulated by the unit since it opened in 2010, as well as outcome improvements for conditions that are common for this delicate patient population.

“Families as Team Members,” covered patient and family-centered care, including how to enhance the family experience and further staff knowledge. In this session, former SBU parents shared their experience of being a part of the patient care team.

As part of the conference, SBU staff also offered insight into their roles and responsibilities within the unit, as well as the essential tools used by the team in standardizing care for the micro-premature infant.

Conference attendees also had time to devise ways that they could apply information gained from touring the SBU into their own NICU. They also had opportunities to ask questions and seek advice from SBU staff.

Founded in 1989, VON is a nonprofit, voluntary collaboration of health care professionals dedicated to the quality and safety of medical care for newborns and their families. VON comprises more than 900 NICUs worldwide.